Title Page

  • Control ID Number:

  • Control Title:

  • Site:

  • Conducted on:

  • Prepared by:

  • Location:
  • Personnel

MHF Risk Control Measures (CM) Information

  • MHF Control ID:

  • Control Title:

  • Control Description:

  • Is the control description correct/ accurate? Please enter the new description if found any discrepancies?

  • New Proposed Control Title & Description:

Control Category

  • Please select control type category?

  • Is the control category listed above?

  • For other, please specify the control type/ category:

  • Enter the Performance Standard Criteria:

For Alarm

  • Is the control type/ category correct? Otherwise, please select N/A

  • Is the control fully implemented:

  • Does the alarm exist? Has the alarms or the associated equipment been isolated or bypassed?

  • Does a maintenance schedule exist for the alarm, including function test?

  • Is the maintenance schedule for the alarm considered appropriate? E.g. The maintenance schedule meets the requirements established in the RCM or it is otherwise assessed appropriate<br><br>

  • Enter PM reference number in Maximo:

  • Is the control fully functional?

  • Is the alarm maintained in accordance to the schedule? Has all relevant information been obtained for completion of the job (eg. Data sheets/ meters) <br><br>

  • Have all maintenance reports received? Any follow-up activities required have been raised/ completed such as subsequent work orders?

  • What is the history of failure/ incidents? Are calibration results within the critical operating parameter limits?

For Trip/ Interlock

  • Is the control type/ category correct? Otherwise, please select N/A

  • Is the control fully implemented:

  • Does the trip exist? What asset triggers the trip and what asset does it trip?

  • Has the trip and associated equipment been isolated or bypassed?

  • Does a maintenance schedule exist for the trip, including function test?

  • Enter PM reference number in Maximo:

  • Is the maintenance schedule for the trip considered appropriate? E.g. The maintenance schedule meets the requirements established in the RCM or it is otherwise assessed appropriate<br><br>

  • Is the control fully functional?

  • Is the trip maintained in accordance to the schedule? Has all relevant information been obtained for completion of the job (eg. Data sheets/ meters) <br><br>

  • Have all maintenance reports received? Any follow-up activities required have been raised/ completed such as subsequent work orders?

  • What is the history of failure/ incidents? Are calibration results within the critical operating parameter limits?

For Operator Inspection

  • Is the control type/ category correct? Otherwise, please select N/A

  • Is the control fully implemented:

  • Does the operator inspection exist?

  • How is the requirement for operator inspection documented?

  • Are the requirements considered clear and appropriate?

  • Enter the SOP and Clause reference numbers:

  • Is the control fully functional?

  • Is there a record of the Operator having undertaken an inspection as described?

  • Take a photo of the last completion record sheet for evidence:

  • Any follow-up activities are completed as required? (E.g. Corrective work orders raised?)

For Procedure (Standard Operating Procedure)

  • Is the control type/ category correct? Otherwise, please select N/A

  • Is the control fully implemented:

  • Does the procedure exist? Is it located in the controlled document library in Inflo?

  • Enter the SOP and Clause reference numbers:

  • Does the procedure have adequate review frequency and management sign-off (review information located in the categories tab in Inflo)?

  • Is the procedure current (e.g. No outstanding review/ work flows)?

  • When the procedure was last reviewed?

  • Is the procedure accurate and does it contain sufficient detail?

  • Is the control fully functional?

  • Have site personnel been adequately trained or been provided on-the-job familiarisation for the procedure?

  • Is there any substantive evidence of the procedure not being followed or being breached?

For Maintenance Inspection

  • Is the control type/ category correct? Otherwise, please select N/A

  • Is the control fully implemented:

  • Is the control tagged as an MHF Asset in Maximo?

  • Enter Maximo Location ID Number:

  • Enter Asset ID number in Maximo:

  • Does a maintenance schedule exist for the asset?

  • Enter PM reference number in Maximo:

  • Is the maintenance inspection (PM frequency and Job Plan detail) for the asset considered appropriate? <br><br>(E.g. The maintenance schedule meets the requirements established in the RCM or is otherwise assessed as appropriate)

  • Is the control fully functional?

  • Is the asset maintained in accordance to the schedule? Has all relevant information been obtained for completion of the job (eg. Data sheets/ meters) <br><br>

  • Have all maintenance reports received? Any follow-up activities required have been raised/ completed such as subsequent work orders?

  • What is the history of failure/ incidents?

Raised Actions/ Recommendations

  • Please contact your area MHF Coordinator and discuss the actions/ tasks to be completed with the actioners

  • All actions are to be entered into MHF Action Register database and please contact MHF Coordinator for individual unique reference number for monitoring/ tracking its completion progress.

  • Action 1:

  • Action 2:

  • Action 3:

  • Action 4:

  • Action 5:

Control Review Ratings/ Audit Findings

  • Audit Findings:

  • Enter Control Rating (0-6 Scale):

  • Please contact your site MHF Coordinator if you determined poor control performance with rating 0, 1, 2 or 3 at the end of the review.

Other comments

  • Please enter other comments (if any):

  • Other supporting evidence/ photos:

Signature

  • Please sign here:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.